Confusion Overview
Confusion is a symptom that makes you feel as if you can’t think clearly. You might feel disoriented and have a hard time focusing or making decisions. Confusion is also referred to as disorientation and in its extreme state, it’s referred to as delirium.
If you or someone you care about is confused for a long period of time, dementia might be the reason. Dementia is a progressive condition caused by brain function decline that results in the loss of your ability to perform everyday functions. It also affects judgment, memory, and behavior.
Confusion can occur with many medical conditions. It involves changes in attention and thinking.
When a person has confusion, they may feel unsure about their surroundings, history, or identity. They may also feel disconnected from reality or have trouble voicing a coherent, linear thought.
Anyone who experiences confusion with no clear cause should receive medical care immediately.
Signs and Symptoms of Confusion
Symptoms of confusion include problems with short-term memory, difficulty carrying out tasks, poor attention span, unclear speech and difficulty in following a conversation.
Following are some of the signs and symptoms of confusion:
- Abnormal or incoherent speech
- Forgetting what a task is while it’s being performed.
- Lacking awareness of location or time
- Forgetting basic facts, such as the year or who the president is
- Slurring words or having long pauses during speech
- Sudden changes in emotion, such as sudden agitation
- Unable to think clearly.
- Uncertain what is happening in the surroundings.
- Unsure what day or what time it is.
Confusion is a term that refers to a decline in cognitive ability, that is, our ability to think, learn and understand. A decline in cognitive ability is often associated with. dementia.
Confusion may come on quickly or develop over time (more so in older people) and can range from mild to severe. It may cause:
- Anxiety
- Aggression
- Frustration
- Unusual behavior or mood swings
Causes of Confusion
The causes of confusion, or delirium, can be complex, and they tend to relate to another health issue. There are a number of factors that can cause confusion, from serious health problems to vitamin deficiencies. Alcohol intoxication is a common cause of confusion.
For instance, a person with dementia might develop confusion after surgery, after a fall, or after starting to take certain medication.
When a person has a condition that increases the risk of confusion, such as dementia, there is usually a specific trigger.
Following are some common causes of confusion:
Age
Age is a significant risk factor for confusion. Various studies estimate that 10–25% of older people who are hospitalized have symptoms of confusion when they arrive at the hospital.
Age is also the most significant risk factor for dementia, as well as for mild cognitive impairment.
Mild cognitive impairment is associated with age-related memory and thinking problems. These are more severe than those that occur with regular aging, and in some people, mild cognitive impairment precedes dementia.
Concussion
A concussion is a brain injury that occurs as a result of head trauma. A concussion can change someone’s level of alertness as well as their judgment, coordination, and speech.
You might pass out if you have a concussion, but it’s also possible to have one and not know it. You may not start to feel confusion due to a concussion until a few days after the injury.
Dehydration
Your body loses fluids everyday through sweating, urination, and other bodily functions. If you don’t replace these fluids often enough, you could eventually become dehydrated.
This can affect the number of electrolytes (minerals) the body contains, which can cause problems with your body’s ability to function.
Medications
Any drug that changes a person’s mental state may cause confusion, especially in people with other risk factors for this issue.
Some examples include the following:
- Antihistamines
- Anesthetics
- Chemotherapy
- Benzodiazepines, a group of anxiety drugs
- Opioids, such as oxycodone
- Sleep medications
Also, some people develop confusion after taking antibiotics, antidepressants, or any of a wide range of medications.
Surgery
Many people develop confusion after surgery, particularly as the anesthetic is just beginning to wear off.
This tends to be more common among older people. Around 15–25% of older people may experience confusion after minor surgeries, while as many as half experience confusion after major surgeries, such as a hip replacement.
Also, pain, pain medication, and unfamiliar surroundings after surgery can contribute to confusion.
Chronic Illness
Numerous chronic illnesses can cause confusion, especially when they progress to damage organs, including the brain.
Some examples include the following:
Sensory Issues
People with sensory problems, such as trouble hearing or seeing, may be more prone to confusion, particularly in new settings. This, too, is more common among older people.
A person who does not have access to their usual assistive devices is even more vulnerable to confusion, such as when an older person leaves their hearing aids at home before going to the hospital.
Unfamiliar Surroundings
Some people develop confusion in unfamiliar settings, particularly during periods of intense stress.
People with other risk factors for confusion, such as dementia, are more likely to experience this issue in unfamiliar places, without the memory cues and references points that they usually rely on.
Brain Health Issues
Any health problem that affects the brain can cause confusion.
Dementia is one of the most common causes of delirium, or confusion, in older people, but delirium does not mean that a person has dementia.
Any injury or illness that changes brain function may cause delirium. Some examples include the following:
- Head injuries that cause concussion
- Infections in or around the brain
- Lesions, growths, or cancer in the brain
- Swelling of the brain
Other Causes of Confusion
Virtually any health condition can trigger confusion, especially in people with risk factors.
Some other potential causes of confusion include the following:
- Changes in the endocrine system, which produces hormones.
- Drug abuse
- Fever
- Infection
- Intense pain
- Lack of oxygen
- Low blood sugar
- Malnourishment
- Rapid drop in body temperature
- Sleep deprivation
- Stroke
- Seizures
Delirium in Older Adults
Older people have a higher risk of developing delirium, a sudden onset of confusion. Anyone who experiences this should receive urgent medical care.
Research suggests that older adults with delirium and other health issues have a less favorable outlook, overall. For example, a person hospitalized for breathing issues may have a higher risk of returning to the hospital or dying if they also have delirium.
A person can have delirium as well as dementia, and dementia increases the risk of delirium. It can sometimes be difficult to distinguish between the two issues.
In hospitals, about half of older people who have dementia also have delirium. For some older people, confusion during an illness is an early warning sign of dementia. For others, an illness worsens preexisting dementia symptoms.
Some older people develop new or worsening confusion when they are sick, especially if they have dementia. Also, urinary tract infections often cause confusion in older people.
Headaches and Confusion
A headache and confusion can signal a serious health problem, such as a stroke or brain injury. Seek immediate care for these symptoms, especially if the headache feels different from headaches in the past.
However, not all headaches that cause confusion are emergencies, some people with migraine headaches develop confusion during episodes.
Anyone who gets headaches frequently should consult a doctor about how to tell when to seek emergency help or schedule an appointment.
Treatment of Confusion
For short-term cases of mild confusion caused by nutritional imbalances, dehydration, or sleep deprivation, you might find relief in treatment at home.
If the cause of your confusion is low blood sugar, drinking a sweetened beverage or eating a small piece of candy may be all you need to relieve your symptoms.
If the confusion is caused by dehydration, drinking water or electrolyte drinks can help relieve your symptoms.
However, confusion due to a head injury requires immediate medical attention. If your confusion is caused by a concussion, your doctor will decide when it’s best to release you from treatment.
They’ll give you advice on how to structure your lifestyle around treating your concussion, such as eating light foods and avoiding alcohol for some time. You may not need to stay in bed, but you should have someone check on you every few hours if you think you may fall asleep within the first 12 hours of having a concussion.
Prognosis of Confusion
Confusion that develops without a clear cause can result from a serious health problem. But many issues that cause confusion are highly treatable, the person may simply need antibiotics, fluids, or monitoring in a hospital.
Overall, the earlier a person receives care, the better their outlook is.
For people with other health problems, their prognosis tends to be more serious if they also develop confusion. This includes people with chronic illnesses and those who have just had surgery.
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